JOVE Application Form

The information requested below is used to provide needed contact information, to determine your eligibility, to determine how best to serve you, and to ensure your entitlements are known to you.

Contact Information

Fields with an asterisk (*) are required.

Last Name (*)

Please type your last name.

First Name (*)

Enter your first name

MI

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Street

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City/Town (*)

Please enter City/Town

State (xx) (*)

Please enter state (xx)

Zip

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Please enter at least one phone number below

Home Phone

Enter valid phone (123-456-7890)

Check if preferred daytime phone

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Cell Phone

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Check if preferred daytime phone

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Email (*)

Please enter a valid email address.

Service Information

Branch of Service (*)

Please choose from the list

Years of Active Service (*)

Please enter numbers only.

Total Years of Service

Please enter numbers only.

Separation Date (Final Discharge)

Separation date (yyyymmdd) (*)

Please enter separation date (yyyymmdd)

Military Medical Retiree

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Temporary Disability Retired List

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Type of Discharge (*)

Pick from the list

Age (*)

Please enter numbers only.

Military Skill Speciality (include Alphanumeric Code if known).

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Period of Service

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Combat Theater Vet (Deployed)

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VA Enrollment Information

Enrolled in Healthcare System

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Enrolled in 5 Year Combat Theater Vet Program

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Have VA Disability Compensation or Pension

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Have met with an accredited veterans service officer

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Have met with a VA vocational rehab & employment counselor

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Are using a vocational rehab and employment service program

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Enrolled in another disability program from state or federal government

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CareerLink Information

Attended CareerLink's “Introduction to Services” session(s)

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Enrolled in CareerLink Job Club

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Have seen a CareerLink Veterans Employment Representative

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Rep Name (if remembered)

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Enrolled in another job program

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Completed another job program

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Last civilian position or job title

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Last civilian industry worked in

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Name of last employer's business

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Last employment date (yyyymmdd) (*)

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Years of employment there

Please enter numbers only.

Qualifications

Check up to 3 career categories for which you think you are qualified

Construction

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Electrical/Mechanical

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Manufacturing/Ops

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Government

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Administration

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Distribution

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Regulatory/Quality Control or Assurance

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Purchasing

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Retail

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IT/IS/Web/e-commerce

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Sales/Marketing/Business Development

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General Management/Executive

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Education/Certifications Information

List educational institute and other career training; certificates and licenses

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Other Information
Please make a selection for the next two questions.

Will you help others by sharing job leads and by continuing to network after finding employment?

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How did you first hear about JOVE?

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Additional Remarks

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AntiSpam (*)

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FOR JOVE COMMITTEE USE ONLY

CL Intro

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Member sign-in sheet

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Added to Database

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Added to Yahoo Groups

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New member info sent

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Coaching

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Profile and resume posted

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Change in status date

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Status change on sign-in sheet

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Exit from sent date

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Removed from Yahoo Groups

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Database updated

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P&R removed

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Remarks

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LVMAC